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News Roundup: March 11, 2013

Health sector adds 32,000 jobs as unemployment falls

Published by The Hill Healthwatch
Sam Baker
March 8, 2013

The healthcare sector added 32,000 jobs last month, continuing its record of consistently strong gains.
Doctors' offices and outpatient health centers saw the biggest gains, adding 14,000 jobs in February. Nursing homes added 9,000 new workers, and hospitals also added roughly 9,000 jobs, according to data released Friday by the Labor Department.
Healthcare has been a consistent leader in the steadily improving employment rate. The sector added 23,000 jobs in January, when employment in healthcare had jumped by 320,000 over the year.

PHI: Home Care Workers to Become Nation’s Fastest-Growing Occupation

Published by Home Health Care News
Jason Olivia
March 7, 2013

The demand for direct-care workers will continue to outpace labor supply through the decade, according to a report from the Paraprofessional Healthcare Institute (PHI).

With as many as 3.3 million workers—including nursing home aides, home health aides and personal care aides—employed in 2010, PHI projects that 1.6 million new positions will arise by 2020.

“Pressure is building to improve the quality of direct-care jobs,” says PHI Policy Research Director Dorie Seavey, Ph.D.

The economy’s demand for direct-care workers according to Seavey, means that it is more essential than ever to attract people to these jobs by making them competitive with other occupations.

By 2020, PHI projects that the direct-care workforce will outnumber all retail sales workers as well as all teachers from kindergarten through high school.

Care aides are also expected to be the fastest-growing occupations in the nation between 2010 and 2020, PHI notes, increasing by 71% and 69%, respectively.

Personal care aides and home health aides rank third and fourth on the list of the top ten occupations projected to generate the most jobs, and outsized growth will result in home and community-based care workers outnumbering facility workers 2:1 by the end of this decade.

Despite rapidly projected growth, the growing demand for these workers has had little impact on wages.

In 2011, he average hourly wage for all direct-care workers was $10.59.

Since public funding represents 70% of spending on long-term care services, PHI recommends that federal and state policymakers take action to ensure that those who provide these care services receive not only “decent” wages, but also benefits along with high-quality training.

New Rule Boosts Home Care For Veterans, Helps Aging in Place

Published by Reverse Mortgage Daily
Jason Olivia
March 7, 2013

The Partnership for Quality Home Healthcare (PQHH) commended a proposed rule by the U.S. Department of Veterans Affairs (VA) that ease regulations permitting Vets to access skilled home healthcare services.

The rule would allow VA to establish provider agreements with non-VA providers currently participating in their State Medicaid plan, eliminating barriers to entry that require non-VA providers to establish federal contract status before they can provide home health services.

The rule also encourages providers to partner with the VA by reimbursing them for services at Medicare and Medicaid rates.

“The VA has once again demonstrated their understanding of home healthcare’s important role in providing clinically-advance and cost effective care to chronically-ill Veterans,” stated Eric Berger, CEO of PQHH.

Greater accessibility of providers across the country, Berger believes, would enable more Veterans to receive optimal health and independence at home while reducing healthcare costs.

Having long been a promoter of home health through its Home Based Primary Care (HBPC) program, VA has been able to provide comprehensive disease management and patient care to Veterans with chronic conditions.

By focusing on providing clinically advanced care in the home, the HBPC program has enabled Vets and their dependents to receive the care they need without having to leave for costly institutional care.

“Since its inception, the Partnership has encouraged lawmakers to look at the VA’s HBPC program as a model for Medicare reform,” added Berger. “We commend the VA for its leadership in utilizing home healthcare services to reduce costs while improving patient outcomes.”

New Research Stresses Accessibility, Affordability of Aging in Place

Published by Home Health Care News
Jason Olivia
March 6, 2013

Various types of service providers from builders and designers of homes to reverse mortgage consultants and Realtors have showed their commitment to the future of aging-in-place as a retirement necessity.

The future of aging in place with respect to the current housing market and senior housing preferences are spelled out in a study from MetLife Market Institute, finding indicators for the best places where boomers can live into their older years without moving.

Whether it is providing older adults with affordable living options, home renovations to meet the needs of its aging inhabitants, or supplying them with financial equity during retirement, professionals are playing pivotal roles in creating what MetLife calls “livable” communities to foster the aging in place initiative.

Conducted as joint research between MetLife Market Institute and the Stanford Center on Longevity, the Livable Community Indicators for Sustainable Aging in Place study measures indicators that make the best communities for people transitioning into the older age group.

A key finding of the research was housing that is accessible, affordable and adaptable to the changing needs over an individual’s lifespan is a critical component of a livable community.

About 29% of U.S. homeowners age 65 and older live in homes built before 1950, according to study findings, many of which do not include physical features that improve accessibility for older individuals with impairments or disabilities.

Affordable housing could be a “major barrier” to aging in place, MetLife suggests, as a 2004 survey from the Center for Home Care Policy Research found that a majority of adults claimed they spend more than 30% of their income on housing.

The same survey also reported that more than one-third expressed they are note confident their current home will remain affordable as they age.

These seniors not able to cover their housing costs may be at an increased risk for relocation to other housing options such as low-cost housing and even nursing homes, MetLife writes.

“We know people generally prefer to remain where they are as they age, connected to friends and family, and communities lose an economic and social asset when older people leave,” said Sandra Timmermann, Ed.D, director of the MetLife Mature Market Institute.

Strategies to achieve change include adopting incremental changes, focusing initially on low-cost policies and programs, and partnering with other stakeholders, the study writes.

“Local governments should think about how to adapt these indicators to best meet the needs of their residents,” said Amanda Lehning, who collaborated with the Stanford Center on Longevity on the report.

Efforts to help seniors age in place also has the potential to improve the community as a whole, Lehning says, as older adults not only can make valuable contributions as neighbors, caregivers and volunteers, but also patronize local businesses and are a factor in tax revenues.

New Senior Living Approach Merges Home Care With Community

Published by Home Health Care News
Jason Olivia
March 4, 2013

Senior care no longer entails simply caring for the elderly, but a relatively new kind of group approach including people of all ages is making headway in one New York community, write the Associated Press.

Fellowship Community is an adult home located 30 miles from Manhattan in Chestnut Ridge, New York, where seniors, adults and children all live and work under one roof.

Founded on a unique philosophy that focuses on spiritual knowledge and a practice of individual development, Fellowship seniors are at the center of the community’s mission.

The AP writes:

At the Fellowship Community‘s adult home, workers are paid not according to what they do, but what they need; aging residents are encouraged to lend a hand at the farm, the candle shop or the pottery studio; and boisterous children are welcome around the old folks.

“It’s a great place to live, and I think there’s probably no better place in the world to die,” says Joanne Karp, an 81-year-old resident who was supposed to be in her room recovering from eye surgery but instead was down the hall at the piano, accompanying three kids learning to play the recorder.

At most adult homes, a resident in decline would eventually have to go to a hospital or nursing home. But Fellowship has an exemption from state law that allows dying residents to stay there because “people have wanted to stay, and we have wanted to keep them,” said administrator Ann Scharff, who helped found the community.

“We provide a space in which people can prepare to die in a way that is accepted and nourishing to them and fraught with meaning,” Scharff said. “It’s not something you run away from, but it’s part of the whole spectrum of life, just as birth is part of life and is prepared for.”

Organizers decline to call it a commune but concede the spirit is similar. The philosophy behind it is called anthroposophy, “a source of spiritual knowledge and a practice of inner development,” according to The Anthroposophical Society in America.

The home is licensed and inspected by the state, writes AP, but does not accept federal or state aid. Instead, workers are paid according to need, with their housing, food and transportation included in the community’s required fees.

These fees include what AP writes is a “life lease” of $27,500-$50,000, in addition to rent, which can range anywhere between $700-$1,500 per month.

In New York, Palliative Care Adds A Layer Of Support For The Seriously Ill

Published by Kaiser Health News
Michael Ollove
March 4, 2013

The palliative care team at Mount Sinai Hospital gathers on a Thursday morning to exchange the latest information on the patients in their ward. It is a raw, unforgiving day outside, but the weather, the news, most everything beyond these walls are concerns that patients on this ward do not have the luxury to worry about. Theirs is a shrunken world measured in degrees of pain, blood pressure, heart rate, and a set of poor options – none of which any healthy person would welcome.

The simplest definition for palliative care is that it is treatment designed to reduce the pain, discomfort and stress associated with a serious disease. But it also entails eliciting from patients and families in dire circumstances their priorities and wishes to make sure the treatment conforms to those desires.

New York State felt so strongly about the importance of palliative care that last year it enacted pioneering legislation to make certain all those with advanced illnesses had access to this sort of treatment. Now other states are considering following New York’s lead.

Around the oval conference table sit two palliative care doctors, three palliative care nurses, a social worker, an art therapist and a chaplain, who, in this case, is a rabbi. Other nurses enter the room one-by-one to give updates on the patients they are tending to.

The unit is much quieter than most acute-care wards, with far less clattering and beeping medical machinery in order to keep the unit as serene as possible. Occupying one of the 13 beds in the unit today is a 28-year old Brooklyn man with liver failure. Death is imminent, one of the doctors, Stephen Berns, says. Days if not hours. Although the man’s pain can be addressed, his elderly grandparents worry that he will die before their parish priest arrives to perform a baptism. The rabbi, Edie Meyerson, tells the group that she has researched the issue and learned that any Christian can perform a baptism, if it should come to that.

A few doors down lies a 77-year old woman, a one-time deputy superintendent in the state’s corrections system. Her breast cancer has metastasized throughout her body and now all her organs are blinking off. Her closest relatives -- two cousins and a niece, the latter her health proxy, have asked that she be removed from the ventilator that appears to be all that is keeping her alive. “We know this is not what she would want,” her cousin says later that day. “She would not want to be on all these machines.”

Then there is a 48-year old man from Puerto Rico with an inoperable tumor in his throat. His face is swollen to such an extent that he can’t open his eyes and his lips have ballooned into protuberances. He has found that even with painkillers, the only tolerable position is to sit cross-legged on his bed, leaning forward with his head cushioned on a pile of pillows. The team wants to start him on steroids to reduce the swelling, but the patient is already hinting that he has had enough.

Advanced Life Limiting Conditions

The cast of characters on the ward today is not atypical. Statistically, most patients on the ward will die here; a minority will improve enough to enable them to depart, usually to their homes, a nursing home or other health care facility. For all of them, the goal of the staff is to provide care that best accords with their wishes, whether that be an end to life-prolonging efforts, relief from the symptoms that are afflicting them, or some combination of the two.

The New York law passed last year ensures that everyone in the state with “advanced life limiting conditions or illnesses who might benefit from palliative care” not only be informed of these services by their healthcare provider but that the provider facilitate access to that care if they desire it. Violations are subject to fines of up to $10,000 and a prison term of up to a year. (According to the state health department, no one has yet been charged or prosecuted under the law.)

“That was a major step,” says Amber Jones, a consultant on palliative care in New York. “It shone a light on the need patients and families have for information.”

This year, legislatures in several other states are considering their own palliative care legislation at least partly modeled after the New York law. Those states include Rhode Island, New Hampshire, Connecticut, Vermont, Massachusetts, Arkansas and Michigan.

Even as legislation advances, there remains widespread confusion about what palliative care is. “There is a misunderstanding among the public that palliative care means end of life care,” says Jay Horton, director of the Palliative Care Consult Service at the Lilian and Benjamin Hertzberg Palliative Care Institute at Mount Sinai. “Many clinicians have the same view.” But the view is not accurate.

Palliative care provides an added layer of support for seriously ill persons and their families. It is delivered alongside all other disease treatments, in an effort to ease the suffering caused by both the disease and its treatment. Palliative care is always part of the treatment for someone in hospice care, that is, someone with a short prognosis who wants to forego further disease intervention.

But palliative care is also appropriate for many others with serious or chronic illnesses, such as leukemia, lymphoma (which is cured in a significant number of patients), heart failure, emphysema, renal failure, and dementia (with which people can live for years.) One common misconception about palliative care is that it is mutually exclusive with treatment for the underlying disease, that it only comes into play when all hope of cure is gone. That is not the case. “Just because you are undergoing palliative care doesn’t mean you are giving up on other treatment,” Horton says.

Discussing Options

Practitioners are quick to point out that palliative care, as it is practiced today, entails far more than the relieving of symptoms. Providers with specialized palliative care training help patients and their families understand complicated medical terminology and the options facing them. They also elicit from their patients what their goals are in the face of what is likely to be a grim situation. Some patients, for example, might be willing to endure any number of invasive procedures in order to extend their lives. Others might prefer to forego such treatments, focusing instead on living at home and making their last days or months meaningful without pain or extensive medical intervention.

Disease specialists – oncologists, cardiologists, neurologists and others – may well be capable of conducting those conversations and alleviating discomfort. But many are trained to focus only on disease as opposed to quality of life, and are ill-equipped to carry on those conversations; others are loath to give up on “curing” the patient no matter how long the odds or how painful for the patient. “Physicians are trained to treat and cure,” says Kathy McMahon, head of the Hospice and Palliative Care Association of New York State. “They feel like failures if they are not able to cure the patient.”

Under the New York law, physicians and nurse practitioners caring for patients with advanced diseases are required to offer patients (or their proxies) information and counseling on palliative and end-of-life options. The law doesn’t require those providers and institutions to provide palliative care consultation and services, but they must “facilitate access” to those services.

That might seem to promise palliative care services in all appropriate cases. But there is a very large problem. “One of the big challenges to assuring quality of care for all who need it is the workforce crisis,” says Diane Meier, director of the Center to Advance Palliative Care (CAPC). “There are not nearly enough physicians, nursing and social workers with palliative care training.” Although palliative medicine is now a board-certified sub-specialty, nearly half the states offer no post-graduate training in the area.

In New York, the state legislature appropriated $4.7 million in 2007 for palliative care training, but when the recession hit, the money went to other state needs. Meier and other health care advocates in New York are trying to raise money through private donors for palliative care outreach and training. Meanwhile, the Hospice and Palliative Care Association of New York State, the Health Care Association of New York State, and the CAPC are working on web-based outreach.

Inadequate Reimbursement

The workforce shortage relates to another significant problem, which is the poor reimbursement rate for palliative care, particularly for the consultations with patients and their families, which palliative care doctors regard as essential in providing truly patient-centered care. Palliative care is reimbursed at a far lower rate than high-tech services, such as chemotherapy infusions, cardiac catheterization or surgery. Horton says that the reimbursement does not come close to compensating for the care provided. “It makes it hard to keep our doors open,” Horton admits. In fact, the doors only remain open because Mt. Sinai is willing to chip in for what reimbursement doesn’t cover.

But if palliative care doesn’t bring in much money, studies show that it does contribute to significant savings while also improving outcomes. One study co-authored by Meier showed that hospital expenses for those receiving palliative services were $2,642 less per admission than for comparable patients not receiving those services. With as much as 30 percent of Medicare spending going to the 6 percent of Medicare patients who die each year, palliative care offers a promising means for saving money while also delivering medicine that accords with people’s wishes.

Back on the Mount Sinai palliative care unit, the 28-year old man with liver disease died on Saturday. But he had been baptized by then and received last rites. As to the former corrections official, with her room full of family members, she was removed from the ventilator Thursday afternoon. She continued to breathe on her own that day, and the next one, and the next and the next. She died quietly Sunday night.

That leaves the man with the swollen face. His oncologist reported back that there were no more treatment options for his cancer. With that, the palliative care unit administered steroids, which relieved much of the swelling. He was able to lift his head off the pillow and move without excessive discomfort, though the steroids did disorient him some. His one request was that someone sit with him. One of the nurses did so, holding on to his hand.

Home Care helps patients after hospital

Published by Globe Gazette
Kristin Buehner
March 2, 2013

Working in the front lines with patients discharged from Mercy Medical Center-North Iowa are Mercy’s Home Care workers.

“We’re that little extra insurance to help them get back to where they were before they went into the hospital,” said Connie Morrison, Mercy director of Home Care and home medical equipment.

“We’re the link between what happened in the hospital and the primary care physician.”

Home Care services are covered entirely by Medicare and Medicaid, Morrison said.

A primary service performed by the Home Care nurses is medication reconciliation, ensuring patients are set up to take the medications they should be taking on a daily basis and that they understand why.

“One of the biggest reasons for re-admission in the first seven days is trouble with medications,” Morrison said.

Home Care nurses’ duties also include wound care for post-surgery patients, home safety assessments and providing infusions.

The Home Care staff also provides physical therapy, occupational therapy and speech therapy, Morrison said.

An electronic monitoring device called the Health Buddy has been available for Mercy’s Home Care patients for four years. It enables patients to self-monitor their care and includes a training and reinforcement component.

Home Care nurses can monitor the Health Buddies from their office daily, looking for alerts and calling the patient or physician if need be, Morrison said.

“We’re kind of the eyes and ears back in the home.”